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Excisional lipectomy versus liposuction in HIV-associated lipodystrophy

  • Barton, Natalie;Moore, Ryan;Prasad, Karthik;Evans, Gregory
    • Archives of Plastic Surgery
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    • 제48권6호
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    • pp.685-690
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    • 2021
  • Background Human immunodeficiency virus (HIV)-associated lipodystrophy is a known consequence of long-term highly active antiretroviral therapy (HAART). However, a significant number of patients on HAART therapy were left with the stigmata of complications, including fat redistribution. Few studies have described the successful removal of focal areas of lipohypertrophy with successful outcomes. This manuscript reviews the outcomes of excisional lipectomy versus liposuction for HIV-associated cervicodorsal lipodystrophy. Methods We performed a 15-year retrospective review of HIV-positive patients with lipodystrophy. Patients were identified by query of secure operative logs. Data collected included demographics, medications, comorbidities, duration of HIV, surgical intervention type, pertinent laboratory values, and the amount of tissue removed. Results Nine male patients with HIV-associated lipodystrophy underwent a total of 17 procedures. Of the patients who underwent liposuction initially (n=5), 60% (n=3) experienced a recurrence. There were a total of three cases of primary liposuction followed by excisional lipectomy. One hundred percent of these cases were noted to have a recurrence postoperatively, and there was one case of seroma formation. Of the subjects who underwent excisional lipectomy (n=4), there were no documented recurrences; however, one patient's postoperative course was complicated by seroma formation. Conclusions HIV-associated lipodystrophy is a disfiguring complication of HAART therapy with significant morbidity. Given the limitations of liposuction alone as the primary intervention, excisional lipectomy is recommended as the primary treatment. Liposuction may be used for better contouring and for subsequent procedures. While there is a slightly higher risk for complications, adjunctive techniques such as quilting sutures and placement of drains may be used in conjunction with excisional lipectomy.

유방 선근상피종의 세침흡인 세포학적 소견 - 섬유선종과의 비교 - (Fine Needle Aspiration Cytology of Adenomyoepithelioma of the Breast - Comparison with Typical Fibroadenoma -)

  • 윤혜경;정수진;강미선
    • 대한세포병리학회지
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    • 제9권1호
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    • pp.105-110
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    • 1998
  • 유방에 발생한 선근상피종은 드문 양성 종양으로 세침흡인 세포학적 소견이 잘 알려져 있지 않다. 저자들은 조직소견상 관상 선근상피종으로 확진된 23세 여자의 좌측 유방종괴의 세침흡인 세포학적 특징과 전형적인 유방 섬유선종과 비교하여 감별점을 찾아보았다. 세침흡인 세포학적 소견상 흡인된 양이 많아 높은 세포학적 밀도를 보였으며, 배경에는 풍부한 나핵 세포와 점액성 물질이 관찰되었다. 상피세포의 군집의 크기는 작거나 중간 정도였으며, 느슨한 응집성을 보였고, 소수의 촘촘한 응집성을 보이기도 하였다. 상피 세포의 핵은 둥글고 비교적 균일하였으며, 작은 핵소체는 가끔 발견되었으나 핵의 비정형성이나 유사분열상은 관찰되지 않았다. 근상피세포들이 풍부하게 관찰되었으며 응집성이 좋은 상피세포 군집의 변연부를 따라 배열하기도 하였다. 기질 조직은 흡인된 양이 적었으며 섬유성 양상이었다. 전형적인 섬유선종과 구별되는 선근상피종의 세포학적 특징은 응집성이 덜한 상피세포 군집, 불분명한 군집의 변연부, 상피세포의 작은 덩어리가 미만성으로 관찰되는 점과 적은 양의 섬유조직성 기질조직이었다.

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개실술에서 우측흉골우연소절개법을 이용한 최소침투수술 (Minimally Invasive Cardiac Surgery through A Small Right Parasternal Incision)

  • 공준혁;이응배;조준용;전상훈;장봉현;이종태;김규태
    • Journal of Chest Surgery
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    • 제33권9호
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    • pp.723-728
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    • 2000
  • Background: Minimally invasive techniques for open heart surgery are widely accepted in these days. There are minimally invasive approaches by the right or left parasternal incision and another approaches by mini-sternotomy of upper or lower half or sternum. We report the safety and efficacy of minimally invasive technique with right parasternal incision compared with the routine full sternotomy. Material and Method: From April 1997 through February 1999, 20 patients(Group A) underwent minimally invasive cardiac operations. We chose 41 patients(Group B) whose preoperative diagnosis were the same and general conditions were similar and who underwent routine full sternotomy before April 1997. We compared A group and B group in many aspects. We performed routine full median sternotomy in B group but we did a minimally invasive technique through a small right parasternal incision in A group. Result: mean age was 36.1 years in both groups. In disease entities, there were 11 cases of ASD, 9 cases of mitral valve disease in group A, and 16 cases of ASD, 25 cases of mitral valve diseases in group B. In ASD, operation time, cardiopulmonary bypass time of aortic occulusion time were 263 min, 82 min, and 41 min in group A and 180 min, 53 min, and 32 min in group B. In mitral valve disease, operation time, cardiopulmonary bypass time and aortic occlusion time were 267min, 106 min, and 70min in A group and were 207 min, 82 min, and 69 min in group B. There were significant differences in operation time, CPB time, and ACC time between group A and group B. There was a significant difference in the amount of bleeding in postoperative day 1 between group A and group B of mitral diasease. However, there was no significant difference in the amount of bleeding in other comparisons. Mean length of incision was 8.7 cm in group A. There was no significant difference in postoperative complications between A group and B group. There was no mortality in either group. Conclusion: We conclude that this minimally invasive technique with right parasternal incision is cosmetically excellent but it is not effective in reducing operative time and there was no significant difference in recovery time and postoperative complications compared with routine full sternotomy.

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종격동염의 증례보고 (Mediastinitis: a case report)

  • 김재환;류동목;지유진;이정우;이덕원
    • Journal of the Korean Association of Oral and Maxillofacial Surgeons
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    • 제36권6호
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    • pp.538-542
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    • 2010
  • Acute mediastinitis is a fatal infection which occurs related to connective tissue of mediastium, in the thoratic organs. Occurrence of mediastinitis due to craniocervical infection is very rare, and is defined as descending necrotizing mediastinitis. November 8th, 2008, man in his early fifties visited ER due to severe swelling on left neck area and dyspnea. Antibiotic were administered immediately, and vast amount of abscess formation on pneumomediastinum and adjacent tissues were observed via chest computed tomography. With cooperation of thoracic and cardiovascular surgery department, emergency incision and drainage with drain insertion was done to remove abscess, and control the infection. After surgery, everyday saline irrigation through drain was done during hospitalization, with continues antibiotic therapy. Descending necrotising mediastinitis is a most rare and dangerous infection which occurs on oropharyngeal area. In case of descending necrotising mediastinitis, accurate diagnosis, airway maintenance, remove of abscess by incision and drainage, aggressive antibiotic therapy and continuous saline irrigation is necessary to increase patient survivability. Also, computed tomography with contrast media is essential to figure out the size and location of the infection and abscess formation.

고양이 전염성 복막염에 의한 흉막폐렴 1례 (Pleuropneumonia in a Cat with Feline Infectious Peritonitis)

  • 박승조;배연호;최지혜
    • 한국임상수의학회지
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    • 제32권5호
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    • pp.454-458
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    • 2015
  • 1년령의 고양이가 호흡 곤란 주증으로 내원하여, 방사선, 초음파, CT 검사에서 우측 후엽의 폐 종괴, 다수의 흉벽 종괴를 동반한 흉막 비후, 다량의 흉수 소견이 확인되었다. 두 달 뒤 소장과 좌측 신장에서 다수의 결절들이 추가로 관찰되었고, 조직 검사와 면역 염색을 통해 고양이 전염성 복막염과 흉막 폐렴으로 진단되었다. 비삼출성 고양이 전염성 복막염에 의한 화농육아종성 폐렴이 발생한 한 마리 증례가 보고되어 있으며, 방사선 검사에서 폐엽의 경화상이 관찰되었다. 본 증례는 삼출성 고양이 전염성 복막염에서 흉막 폐렴이 다수의 종괴 양상으로 관찰된 드문 증례로 영상학적 특징을 평가한 첫 보고이다.

결핵성 흉막염 치료 후 반복되는 가성유미흉의 수술적 치료 (Surgical treatment of recurrent pseudochylothorax occurring after therapy of tuberculous pleurisy)

  • 이재령;김우식;정은정;정유나;이희숙;조기호;이지연
    • Journal of Yeungnam Medical Science
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    • 제31권1호
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    • pp.65-68
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    • 2014
  • Pseudochylothorax is an uncommon pleural effusion disease characterized by the presence of cholesterol crystals or high lipid content not resulting from a disrupted thoracic duct. Most of the cases reported so far had been found in patients with long-standing pleural effusion due to a chronic inflammatory disease such as old tuberculous pleurisy or chronic rheumatoid pleurisy. Authors encountered a case of pseudochylothorax in a 45-year-old man who had been treated for tuberculous pleurisy 6 years before his visit to authors' hospital. After that, he had visited the emergency department many times for removal of pleural effusion. The patient's chest X-ray revealed dyspnea and large left-sided pleural effusion. Although a large amount of pleural fluid was removed with a drainage catheter, massive pleural effusion was likely to recur, and the underlying lung was able to fully re-expand. Accordingly, decortication was done, and the patient's symptom was improved without postoperative complications.

진도견에서 발생한 원발성 결막 비만세포종양 1예 (Primary Conjunctival Mast Cell Tumor in a Korean Native Jindo Dog)

  • 이재연;정성목
    • 한국임상수의학회지
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    • 제30권2호
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    • pp.131-133
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    • 2013
  • 9 년령 23 kg의 암컷 진도견이 2개월 동안의 안구 분비물을 주요증상으로 본원에 내원하였다. 초기 안검사에서 좌측 아래 안구 결막 부위에서 크기 2 cm의 길게 돌출 된 종괴를 발견하였다. 다른 안구 및 주위 조직의 이상소견을 확인하기 위해 안구초음파를 실시 하였고 모두 음성으로 판명되었다. 또한 흉 복부에 실시한 X-ray 검사에서도 특이 소견이 관찰되지 않았다. 세포학적 검사에서 다수의 원형세포와 중등도의 호산구 (eosinophils)가 관찰되었다. 종괴는 외과적으로 절제되었고 조직학적 검사를 통해 비만세포종 (mast cell tumor)로 진단되었다. 수술 후 6개월 뒤 실시한 흉복부 X-ray 및 초음파 검사에서 종양의 전이 또는 재발은 관찰되지 않았다.

CT 이미지 세그멘테이션을 위한 3D 의료 영상 데이터 증강 기법 (3D Medical Image Data Augmentation for CT Image Segmentation)

  • 고성현;양희규;김문성;추현승
    • 인터넷정보학회논문지
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    • 제24권4호
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    • pp.85-92
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    • 2023
  • X-ray, Computed Tomography (CT), Magnetic Resonance Imaging (MRI)과 같은 의료데이터에서 딥러닝을 활용해 질병 유무 판별 태스크와 같은 문제를 해결하려는 시도가 활발하다. 대부분의 데이터 기반 딥러닝 문제들은 높은 정확도 달성과 정답과 비교하는 성능평가의 활용을 위해 지도학습기법을 사용해야 한다. 지도학습에는 다량의 이미지와 레이블 세트가 필요하지만, 학습에 충분한 양의 의료 이미지 데이터를 얻기는 어렵다. 다양한 데이터 증강 기법을 통해 적은 양의 의료이미지와 레이블 세트로 지도학습 기반 모델의 과소적합 문제를 극복할 수 있다. 본 연구는 딥러닝 기반 갈비뼈 골절 세그멘테이션 모델의 성능 향상과 효과적인 좌우 반전, 회전, 스케일링 등의 데이터 증강 기법을 탐색한다. 좌우 반전과 30° 회전, 60° 회전으로 증강한 데이터셋은 모델 성능 향상에 기여하지만, 90° 회전 및 ⨯0.5 스케일링은 모델 성능을 저하한다. 이는 데이터셋 및 태스크에 따라 적절한 데이터 증강 기법의 사용이 필요함을 나타낸다.

트랙터 부착용 유채파종기 개발 (Development of a Rapeseed Seeder Attached to Tractors)

  • 이충근;최용;전현종;최덕규;김영주;이승규;문성동;한병희
    • Journal of Biosystems Engineering
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    • 제34권3호
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    • pp.147-154
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    • 2009
  • Suitable rapeseed cultivation techniques of domestic agriculture are essential for stable security, supply and demand of rapeseed. This research developed a rapeseed seeder for bio-diesel and analyzed the seeding performance improving an existent granule fertilizer applicator. The relational expression of metering groove size and discharge rate per time displayed high correlation with a coefficient of determination of 0.988. Also, the scattering types were analyzed by forwarding speed and discharge rate. Validity application width was decided as 7.0 m by analyzing application uniformity at application widths of 7.6 m, 6.6 m, 5.6 m. All average coefficients of variation values were less than 20%. The best application uniformity was obtained in the condition of a work speed of 1.3 m/s and a sowing rate of 19.0 g/s. It was better average coefficient of variation values under 10% at superposition application of rapeseed seeder. Also, scattering amount rates of right and left were within 0.89${\sim}$1.0.

유방암 환자의 cyclophosphamide, doxorubicin 유발 부작용에 대한 약침을 포함한 통합 암 치료 1례 (A Case Report of Cyclophosphamide plus Doxorubicin-induced Side effects in Patient with Both Sides Breast Cancer Treated with Integrative Medicine Therapy Including Pharmacopuncture.)

  • 김민서;정유진;홍상훈
    • 대한암한의학회지
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    • 제23권1호
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    • pp.33-43
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    • 2018
  • Objectives: To observe the mitigating effects of a Traditional Korean Medicine(TKM) treatment program especially including pharmacopuncture, with Cyclophosphamide and doxorubicin chemotherapy on a both sides breast cancer patient. Methods: AA 74 year-old female patient diagnosed with both sides breast cancer (Right) pT1bpN0M0, (Left) pT1cpN1Mx was admitted to hospital of Dong-eui university in May of 2017. She received Cyclophosphamide and Doxorubicin from May $31^{st}$ to August $2^{nd}$, 2017 followed by TKM treatment consisting of herbal medicine, acupuncture, moxibustion and pharmacopuncture (Trionycis Carapax, Non-toxic Bee Venom, and Cultivated Wild Ginseng Extract) for a period of almost 4 months, from May $13^{th}$ to August $19^{th}$, 2017. Symptoms were evaluated by the grade of chief complaints refer to Common Terminology Criteria for Adverse Events (CTCAE) and Eastern Cooperative Oncology Group (ECOG). Results: TKM including pharmacopuncture alleviated chemotherapy-induced nausea, fatigue, joint pain, diarrhea, insomnia. Conclusions: This case study potentiates TKM with pharmacopuncture's significant efficacy in aiding breast cancer patients suffering from Cyclophosphamide plus Doxorubicin induced adverse effects. Further research should take place for clear understanding of the exact amount of dosage and safety. Moreover it must be accompanied by long-term follow up researches.